The procedures which are currently employed for the occlusion of target vessels during surgical procedures such as laproscopies include the attachment of clips to these vessels with clip applying devices which can be extended into the target area and then, by means of external triggers, close a pair of jaws for the purpose of closing the clip onto the target vessel.
Conventional clip application requires the surgical exposure and 360.degree. isolation of the intended vessel (or targeted structure). This requires careful and accurate dissection in order to insure proper placement and secure clip engagement. As shown in FIG. 39, the vessel is then positioned well within the opened jaw members of this prior art device, so that U-or V-shaped clip can be applied with any degree of assurance that its distal arms will meet for successful engagement. The jaw members of the instrument thus remain parallel to each other upon closure, and thereby perform the crimping action for clip application. A serious problem with these devices relates to the fact that in real environments there are any number of impediments to adequate vessel mobilization. It is therefore necessary in many cases to carry out precise clamping and ligation.
The conventional clip application method has been applied to therapeutic laproscopies. Thus, endoscopic devices have been widely applied to abdominal procedures, such as cholecystectomy, appendectomy, and lysis of intestinal adhesions. Endo-cholecystectomy, for example, requires clip ligation of the cystic duct and cystic artery. Meticulous dissection can be tedious, especially in the presence of inflamed tissues. In any event, the prior techniques and devices have not satisfactorily afforded accurate ductal and vascular control, along with the assurance of precision clip application.
The procedure which is generally employed in connection with simple vasectomies includes grasping the vas deferens with an appropriate instrument and making an incision to the adjacent subcutaneous tissue. The vasal sheath is then grasped with a clamp and incised with the vas being dissected from the sheath. The vas is then isolated and a segment is excised whereupon the distal end of the vas is electrocoagulated and/or ligated and then buried within the vasal sheath. The proximal end of the vas is also electrocoagulated and/or ligated, and finally the skin can be closed.
Although the latter procedure has proven to be quite reliable, it is the subject of a number of disadvantages. In particular, this above-described procedure is relatively time-consuming, requiring on the order of at least about 40 minutes or so. The conventional procedure thus requires a surgical incision, entailing all of the necessary precautions normally incident to relatively complicated surgical procedures.
Procedures for the percutaneous occlusion of the vas deferens in a vasectomy have thus been generated in which a mechanical clip is applied to the vas deferens as taught forth in U.S. Pat. No. 4,394,864, in the name of the inventor in the present application. This patent discloses an apparatus and method for effecting occlusion of the vas deferens including a pair of pivotally coupled jaws for receiving a U-shaped locking clip therein, so that after the locking clip is placed between the jaws, closure of the jaws entirely effects closure of the locking clip therein. Although this apparatus has provided a major improvement in the performance of such vasectomies, it relies entirely upon the pivoting of the jaw members to effect the closure of the clip, a movement which is not always desirable in such surgical procedures. The search has therefore continued for improved devices to eliminate this shortcoming and further facilitating both the vasectomy procedure, and the general use of such procedures for laproscopies.